[Federal Register: March 24, 2003 (Volume 68, Number 56)]
[Notices]
[Page 14240-14242]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID: fr24mr03-68]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Preliminary Measure Set for Home Health in the National
Healthcare Quality Report—Request for Comments
AGENCY: Agency for Healthcare Research and Quality, HHS.
ACTION: Request for comments.
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SUMMARY: The Agency for Healthcare Research and Quality (AHRQ)
announces a request for public comment on the Preliminary Measure Set
on home health to be used in preparing the National Healthcare Quality
Report (NHQR). The NHQR is a congressionally
mandated annual report (see 42 U.S.C. 299b-2(b)(2)) on national trends
with respect to health care quality. The legislation mandated that AHRQ
submit this report on an annual basis beginning in 2003. The
preliminary Measure Set for the NHQR was generated through a call for
health care quality measures to Federal agencies and private
organizations.
DATES: Written comments on this notice must be received by April 23,
2003.
ADDRESSES: Written comments should be submitted to: Judith Sangl,
Sc.D., Center for Quality Improvement and Patient Safety, Agency for
Healthcare Research and Quality, 540 Gaither Road, Suite 3000,
Rockville, MD 20850; Fax: (301) 427-1341; E-mail: JSangl@ahrq.gov.
Public Review of Comments
Comments and responses received will be available for public
inspection at AHRQ's Information Resource Center (IRC) public reading
room between the hours of 8:30 a.m. and 5 p.m. on regular business days
at 540 Gaither Road, First Floor, Rockville, MD 20850. Arrangements
for reviewing the submissions may be made by calling (301) 427-1280.
Responses may also be accessed through AHRQ's Electronic Freedom of
Information Reading Room on AHRQ's Web site at
www.ahrg.gov/news/foiaindx.htm.
Availability of Technical Expert Panel (TEP) Meeting Transcript and
Background Materials
Copies of the transcript from the TEP meeting are available from
the AHRQ Web site at: www.ahrg.gov/qual/nhqr02/hhmtep.htm.
organizations without access to the Internet, AHRQ will make a paper
version available either through overnight mail or by fax upon written
request. Requests for paper versions of the preliminary measure set
should be faxed to the above fax number. The background materials will
be available in the IRC (see address above).
FOR FURTHER INFORMATION CONTACT: Judith Sangl, Sc.D. (See information
under addresses).
SUPPLEMENTARY INFORMATION:
1. Background
This request follows up on an earlier request for public comments
on the preliminary measure set dated August 19, 2002. At that time, no
home health measures were proposed for the preliminary measure set
because AHRQ was working together with the Centers for Medicare &
Medicaid Services (CMS) to determine as appropriate set of measures for
the CMS public reporting initiative on home health as well as the NHQR.
AHRQ and CMS decided that, in the short term, the Outcome and
Assessment Information (OASIS) measures would be used as the initial
measure set because there is more standardization around these measures
than any other in home health care. This view was reiterated in the one
comment received in response to the August request, i.e., that OASIS
measures were the best currently available to measure the quality of
home health care.
OASIS is a uniform set of patient assessment items developed for
monitoring and measuring outcomes of care, adjusted for patient factors
that might affect those outcomes. The OASIS data set is the only
national, standardized data source on adult home health care delivery.
The OASIS instrument was created over a 14-year period to measure
functional outcomes for the purpose of improving quality of home health
care. It was developed through a scientific process, using input from
the home healthcare industry, and has been tested for validity and
reliability. All Medicare certified home health agencies (HHAs)
implemented the OASIS instrument nationwide for collection and
reporting of comprehensive patient assessments in October 1999. There
are 41 measures derived from OASIS data covering (1) functional
outcomes; (2) physiologic outcome; (3) emotional/behavioral/cognitive
outcomes; and (4) utilization outcome measures. When one includes the
additional 13 low-frequency adverse patient outcomes identified from
OASIS data, there are a total of 54 measures. The Web site at
http://www.cms.hhs.gov/OASIS/ contains extensive detail on the
development of OASIS, a copy of the OASIS data collection form (OASIS
B1) and measure definitions.
Because CMS currently wanted to select a subset of OASIS measures
for its home health public quality reporting initiative, AHRQ decided
to convene a technical expert panel (TEP) to review the set of OASIS
home health quality measures as candidates for both the NHQR and the
CMS home health care public reporting initiative. Accordingly, AHRQ
convened a TEP on October 21-22, 2002 with the purpose of addressing
these two independent but overlapping efforts being planned by CMS and
AHRQ.
2. TEP Composition and Meeting Process
The TEP was composed of 18 members representing a wide range of
disciplines and interests: home health agency representatives,
clinicians (both physicians and nurses), an epidemiologist, consumer
reporting experts and a consumer groups organization, quality
improvement organizations, State survey agencies, and home health
services researchers. The panelist list is included in the meeting
transcript on the AHRQ site at www.ahrg.gov/qual/nhqr02/hhmtep.htm.
AHRQ and CMS staff gave introductory remarks and overviews of the
two parallel purposes and goals of the meeting. Speakers gave
background presentations on: (1) Development of the OASIS measures,
their statistical properties, and their use in quality improvement and
(2) results of testing OASIS measures (in plain language) in focus
group with consumers and interviews with physicians and discharge
planners, who would be users of such quality measure information.
Results of these focus groups are also on the above referenced AHRQ Web
site.
After presentation of the introductory background material, the
meeting facilitator described how the remainder of the meeting would
proceed. Since this technical expert panel was not established as a
formal Federal advisory committee, AHRQ would not seek any formal votes
from the panel nor consensus from the panel members. Instead, the
emphasis would be on viewpoints of the individual panel members as each
of the existing OASIS measures was discussed according to pre-
established criteria (see Attachment A in the meeting transcript on the
AHRQ Web site), derived from criteria for quality measures developed by
the Institute of Medicine for the NHQR. Panelists were given a workbook
with criteria worksheets and statistical properties for each of the
measures. The presenters stayed during the entire meeting for technical
support and clarifications.
At the end of the second day, all of the panel members were asked
to bring together their values, insights and assessments to provide
input to AHRQ on which of the 41 OASIS measures should be priority
items for the two purposes: (1) AHRQ's NHQR and (2) CMS's home health
public reporting initiative. It was acknowledged that these two
priority measure lists might be different.
The meeting was open to the public and representatives from the
home health industry trade associations, industry consultants, agencies
and journalists attended.
3. OASIS Measures Reviewed by Panel
The Panel was charged with focusing on 41 OASIS measures, a subset
of the 54 measures in OASIS. To facilitate discussion, these 41 measures
were put into 13 categories (used in consumer testing) and three domains
(adapted from the Foundation for Accountability framework) as follows:
o Domain: Getting Better
Category 1: Physical Health
Improvements in: Dyspnea, status of surgical wounds, number of
surgical wounds, urinary tract infection, urinary incontinence, bowel
incontinence.
Category 2: Mental Health
Improvements in: Behavior problem frequency, cognitive functioning,
confusion frequency, anxiety level.
Category 3: Meeting Basic Daily Needs
Improvements in: Eating, upper body dressing, lower body dressing,
in bathing, grooming, management of oral medications.
Category 4: Getting Around
Improvements in: Ambulation/locomotion, toileting, transferring,
pain interfering with activity.
Category 5: Meeting Household Needs
Improvements in: Light meal preparation, laundry, shopping,
housekeeping.
Category 6: Talking With People
Improvements in: Speech and language, phone use.
Category 7: Staying at Home Without Home Care
Discharged to community.
o Domain: Living With Illness or Disability
Category 8: Meeting Basic Daily Needs
Stabilization in: Bathing, grooming, management of oral
medications.
Category 9: Meeting Household Needs
Stabilization in: Light meal preparation, laundry, shopping,
housekeeping.
Category 10: Mental Health
Stabilization in: Cognitive functioning, anxiety level.
Category 11: Getting Around
Stabilization in: Transferring.
Category 12: Talking With People
Stabilization in: Speech and language, phone use.
o Domain: Staying Healthy/Avoiding Injury or Harm
Category 13: Medical Emergencies
Any emergency care provided, acute care hospitalization.
CMS and AHRQ focused panel attention on just these 41 measures
because they assess long-term quality improvement issues that every
home health agency should address. These OASIS measures are not
specific to particular diagnoses but the functional outcomes they
measure apply to many diagnoses. There are an additional 13 adverse
event outcome OASIS measures that were not considered by the panel
because they cover events that occur infrequently.
4. AHRQ Proposed Recommendations for Home Health Care Measures for the
NHQR
Based on the Home Health Quality Measures Technical Expert Panel
input, including: the individual panelist prioritization lists (i.e., a
significant proportion of panelists listed particular measures as
priority items for inclusion), their written comments and the meeting
discussion, AHRQ proposes using results collected on the following 12
OASIS measures for reporting on the quality of home health care in the
NHQR:
--Improvement in dyspnea (physical health category);
--Improvement in urinary incontinence (physical health category);
--Improvement in upper body dressing (basic daily needs category);
--Improvement in management of oral medications dressing (basic daily
needs category);
--Improvement in ambulation/locomotion (getting around category);
--Improvement in toileting (getting around category);
--Improvement in transferring (getting around category);
--Improvement in pain interfering with activity (getting around
category);
--Improvement in bathing (basic daily needs category);
--Stabilization in bathing (basic daily needs category);
--Improvement in confusion frequency (mental health);
--Acute care hospitalization (medical emergencies category).
AHRQ is soliciting public comment on this proposed set of 12 home
health care measures selected from the 41 OASIS measures considered.
Ten of these measures are the same as CMS has announced for use in its
initial home health public reporting effort. Based on panel input
regarding the NHQR, AHRQ is recommending two additional measures,
"Improvement in dyspnea" and "Improvement in urinary incontinence."
Finally, although CMS is using the measure, "Any Emergency Care,"
(one of the OASIS measures listed above in Category 13), AHRQ is not
recommending this measure for the NHQR at this time because we believe
that this measure raises some significant issues that warrant further
investigation. AHRQ would like to hear comments on the advantages and
disadvantages of this measure in particular.
Carolyn M. Clancy,
Director.
[FR Doc. 03-6879 Filed 3-21-03; 8:45 am]
BILLING CODE 4160-90-M
540 Gaither Road Rockville, MD 20850